Therapy slowed respiratory decline by almost a third, study found
FRIDAY, Nov. 30 (HealthDay News) -- The common pain reliever and anti-inflammatory ibuprofen significantly slows the decline in lung function seen in children with cystic fibrosis, U.S. researchers report.
A team at Case Western Reserve University School of Medicine, in Cleveland, found that children with cystic fibrosis who took high doses of ibuprofen twice a day had a 29 percent reduction in loss of lung function compared with children who did not take the drug.
"In cystic fibrosis the lungs are destroyed by chronic infection and inflammation. One of the treatments for that would be anti-inflammatory therapy," explained lead researcher Dr. Michael W. Konstan, director of the Cystic Fibrosis Center at Rainbow Babies and Children's Hospital.
One expert agreed that ibuprofen should be more widely used in treating the illness.
"This study confirms the benefit of ibuprofen in children with cystic fibrosis," said Dr. Bruce Marshall, vice president of clinical affairs at the Cystic Fibrosis Foundation.
In fact, the foundation currently recommends ibuprofen therapy. "This paper is in alignment with Cystic Fibrosis Pulmonary Guideline Committee recommendations," Marshall said.
CF is a genetic disease that affects the lungs and other organs. It's characterized by thick, sticky mucus that makes it almost impossible for CF patients to fight off germs and infections. The disease is always fatal, and lung disease accounts for 85 percent of deaths among CF patients. However, advances in treatment in the last 60 years have increased life expectancy from just a few years to about 36 years.
A decade ago, Konstan had shown that daily use of ibuprofen could slow the progression of the disease. "Our hope was that that would translate into increased years of survival," he said.
Since that time ibuprofen therapy has not been used very much, Konstan noted. "Only about 5 percent of patients who are eligible for this therapy are actually treated with ibuprofen," he said.
Part of the reluctance to use ibuprofen is the fear on the part of doctors of increased gastrointestinal bleeding, a common side effect with ibuprofen and other anti-inflammatory drugs, Konstan explained.
But he added that this problem "happens in about one in 500 treated patients. That's an awfully small risk considering the strong benefit."
In the new study, which appears in the December issue of American Journal of Respiratory and Critical Care Medicine, Konstan's team was able to show that the risk of gastrointestinal bleeding was small while the benefit was significant.
Konstan's group looked at 1,365 children who took ibuprofen and 8,960 who did not. Patients ranged from 6 to 17 years of age. Doses ranged from 20 milligrams to 30 milligrams per kilogram of the patient's weight. Some patients took up to 1,600 milligrams per dose -- typical, over-the-counter doses of ibuprofen recommend a maximum dose of 1,200 milligrams for people over 12 years of age.
The researchers found that for patients taking ibuprofen, the progression of the disease was cut by almost one-third compared with those not taking the drug. Moreover, gastrointestinal bleeding was rare, with an incidence of 0.37 percent in children taking ibuprofen, compared with 0.14 percent in those not taking the drug.
"Based on these findings, we should reconsider the use of ibuprofen as a treatment option," Konstan said. Whether ibuprofen actually increases survival isn't known, but based on the slowing of the disease, Konstan thinks that it probably does.
The researcher noted that his team has been looking for an anti-inflammatory alternative to ibuprofen for 10 years, but they have yet to find one that is as effective and safe as the common drug. "We continue to search for alternatives to ibuprofen," Konstan said.
For more information on cystic fibrosis, visit the Cystic Fibrosis Foundation.
SOURCES: Michael W. Konstan, M.D., director, Cystic Fibrosis Center, Rainbow Babies and Children's Hospital, and professor, pediatrics, Case Western Reserve University School of Medicine, Cleveland; Bruce Marshall, M.D., vice president, clinical affairs, Cystic Fibrosis Foundation, Bethesda, Md.; December 2007 American Journal of Respiratory and Critical Care Medicine
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